<%@ page language="java" contentType="text/html; charset=utf-8"
    pageEncoding="utf-8"%>
<!DOCTYPE html PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN" "http://www.w3.org/TR/html4/loose.dtd">
<html>
<head>
<meta http-equiv="Content-Type" content="text/html; charset=utf-8">
<title></title>
<link rel="stylesheet" href="${pageContext.request.contextPath}/static/css/pintuer.css">
<link rel="stylesheet" href="${pageContext.request.contextPath}/static/css/admin.css">
<script src="${pageContext.request.contextPath}/static/js/jquery.js"></script>
<script src="${pageContext.request.contextPath}/static/js/pintuer.js"></script>
</head>
<body>
<div class="panel admin-panel">
  <div class="panel-head" id="add"><strong><span class="icon-pencil-square-o"></span>增加医疗机构</strong></div>
  <div class="body-content">
    <form method="post" class="form-x" action="${pageContext.request.contextPath}/sys/medicalI.do?method=editMedical&tgId=${tgId}&pageNum=1">  
    	<input type="hidden" name="id" value="${medical.id }"/>
    	
      <div class="form-group">
        <div class="label">
          <label>机构编号</label>
        </div>
        
        <div class="field">
          <input type="text" class="input w50"  name="medicalid" value="${medical.medicalId }" data-validate="required:请输入机构编号" />
          <div class="tips"></div>
        </div>
      </div>
      
      <div class="form-group">
        <div class="label">
          <label>机构名称</label>
        </div>
        
        <div class="field">
          <input type="text" class="input w50" name="medicalname" value="${medical.medicalName}" data-validate="required:请输入机构名称" />
          <div class="tips"></div>
        </div>
      </div>
      <div class="form-group">
        <div class="label">
          <label>机构地址</label>
        </div>
        
        <div class="field">
          <input type="text" class="input w50"  name="medicaladdress" value="${medical.medicalAddress}" data-validate="required:请输入机构地址" />
          <div class="tips"></div>
        </div>
      </div>
      <div class="form-group">
        <div class="label">
          <label></label>
        </div>
        <div class="field">
          <button class="button bg-main icon-check-square-o" type="submit"> 提交</button>
        </div>
      </div> 
    </form>
  </div>
</div>

</body>
</html>